Provider Demographics
NPI:1619056934
Name:COLOMBO, ELAINE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIE
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 157TH ST
Mailing Address - Street 2:
Mailing Address - City:BEECHHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2717
Mailing Address - Country:US
Mailing Address - Phone:718-767-1219
Mailing Address - Fax:718-289-2274
Practice Address - Street 1:27111 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1436
Practice Address - Country:US
Practice Address - Phone:718-289-2270
Practice Address - Fax:718-289-2274
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042160183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric